Focus On: Left Ventricular Failure (LVF)

Well my blog is filled with tips on becoming a Student Paramedic and ramblings in my Diary. So I thought I'd try and add some more information for those currently studying or about to begin studying. Prompted by a recent job I attended, I thought we would take a look at Left Ventricular Failure (LVF). Read on to find out more!




What is it?
Well first of all, it's a type of heart failure. Heart Failure can be broadly thrown into two categories, Acute and Chronic - Acute is what we are interested in at the moment and Left Ventricular Failure (LVF) is as it sounds, the failure (though not complete failure, just the severe degradation) of the Left Ventricle. As we're all aware, the Left Ventricle is responsible for firing blood out through the Aorta at high pressure and into Systemic Circulation - If we loose pressure and contractability in this Ventricle then we are going to loose adequate perfusion and start to see congestion. This congestion is most evident in the pulmonary circulatory system as blood 'backs up' through the Left Atrium and the Pulmonary Veins due to the Left Ventricles reduced ability to remove the blood filling its chamber.

Signs and Symptoms
So here we are talking acute severe LVF, where the patient has deteriorated significantly over a few hours which has prompted a call to 999.
D
<C> - N/A

R - Likely to be responsive to Voice or worse due to inadequate brain perfusion
A - Stridor may be audible but unlikely
B - Shortness of breath, even at rest or sometimes exertional SoB, potentially coughing clear or pink frothy fluid, bilateral crackles on auscultation of the chest, a heart murmur may be heard over one or more valves
C - Inadequate peripheral perfusion, >Cap Refil, Systollic BP <90 mmHg, pale, < Level of Consciousness, pitting Oedema in the lower legs and ankles, distention of the Jugular Veins
D - Lowered GCS due to poor perfusion
E - N/A

As you can see, the main things we're looking for is poor perfusion, dyspnoea, and signs of congestion. A 12-Lead may provide an abnormal rhythm of some sort but not always.

Treatment
> Patient supine with upper half elevated 30-45 degrees on the cot if possible.
> GTN
> Furosemide
> If wheeze present and/or Hx of COPD or Asthma consider Salbutamol 
> Consider Morphine if central chest pain present (?ACS)
> Transport to further care

Sources
JRCALC 2013, pg. 152 - 155
http://www.nhs.uk/Conditions/Heart-failure/Pages/Introduction.aspx#close
http://www.patient.co.uk/health/heart-failure-leaflet
http://www.netdoctor.co.uk/diseases/facts/heartfailure.htm